Book Reading
POSTTERM PREGNANCY
Presented By :
DEPARTMENT OF OBSTETRICS AND GYNECOLOGY
FACULTY OF MEDICINE SRIWIJAYA UNIVERSITY
Dr. MOH. HOESIN GENERAL HOSPITAL PALEMBANG
POSTTERM PREGNANCY
The international definition of prolonged pregnancy is
42 completed weeks—294 days— or more from the
first day of the last menstrual period
the American College of Obstetricians and Gynecologists (2013a)
ESTIMATED GESTATIONAL AGE USING
MENSTRUAL DATES
There are two categories of pregnancies that reach 42 completed weeks:
(1) those truly 40 weeks past conception
(2) those of less-advanced gestation but with inaccurately
estimated gestational age
There is no accurate method to identify the truly prolonged pregnancy,
all those judged to have reached 42 completed weeks should be
managed as if abnormally prolonged.
Sonographic evaluation of gestational age during pregnancy has been
used to add precision
INCIDENCE
the incidence of postterm pregnancy
ranged from 4 to 19 percent
In 2000, 7.2 percent of births in
US were 42 weeks or beyond
compared with 5.5 percent in 2009
Rates of induction by gestational age among non- Hispanic
white singleton livebirths ≥ 37 weeks from 1992 through 2003
(Redrawn from Zhang, 2010, with permission.)
PERINATAL MORTALITY
Perinatal mortality rates increase after the expected due date has passed
Perinatal mortality rates in late pregnancy
according to gestational age in Sweden
of all births during 1943–1952 compared
with those during 1977–1978.
The partially compressed scale is used for
convenience in depiction
PERINATAL MORTALITY
PERINATAL MORTALITY
• Perinatal mortality rate and perinatal risk
index for births between 37 and 43 weeks
in Scotland from 1985 through 1996.
• The perinatal mortality rate is the number
of perinatal deaths with delivery in a given
gestational week divided by the total
number of births in that week multiplied
by 1000.
• The perinatal risk index is the cumulative
probability of perinatal death multiplied
by 1000
PATHOPHYSIOLOGY
Postmaturity Syndrome
• The incidence of postmaturity syndrome in infants
at 41, 42, or 43 weeks, respectively, has not been
conclusively determined
• The incidence increased to 33 percent at 44 weeks
• Associated oligohydramnios substantially increases
the likelihood of postmaturity
Postmaturity syndrome.
Infant delivered at 43 weeks’ gestation with thick, viscous
meconium coating the desquamating skin.
Note the long, thin appearance and wrinkling of the hands.
PATHOPHYSIOLOGY
Placental Dysfunction
The concept that postmaturity is due to placental insufficiency has persisted
despite an absence of morphological or significant quantitative findings
There are findings that placental apoptosis—programmed cell death—was
significantly increased at 41 to 42 completed weeks compared with that at
36 to 39 weeks
Mean daily fetal growth during previous week
of gestation
PATHOPHYSIOLOGY
Fetal Distress and Oligohydramnios
Both antepartum fetal jeopardy and intrapartum fetal distress were found to
be the consequence of cord compression associated with oligohydramnios
Prolonged fetal heart rate
deceleration before emergency
cesarean delivery in a postterm
pregnancy with oligohydramnios
PATHOPHYSIOLOGY
Fetal Distress and Oligohydramnios
Severe—less than 70 bpm for 60 seconds or longer— variable
decelerations in a postterm pregnancy with oligohydramnios
PATHOPHYSIOLOGY
Fetal Distress and Oligohydramnios
Saltatory baseline fetal heart rate showing oscillations exceeding 20
bpm and associated with oligohydramnios in a postterm pregnancy
PATHOPHYSIOLOGY
Fetal-Growth Restriction
Stillbirths were more common among
growth-restricted infants who were
delivered after 42 weeks.
Indeed, a third of postterm stillborn
infants were growth restricted.
COMPLICATIONS
Oligohydramnios
the smaller the amnionic fluid pocket, the
greater the likelihood that there was clinically
significant oligohydramnios
Comparison of the prognostic value of various
sonographic estimates of amnionic fluid volume in
prolonged pregnancies.
Abnormal outcomes include cesarean or operative
vaginal delivery for fetal jeopardy, 5-minute Apgar
score ≤ 6, umbilical arterial blood pH < 7.1, or
admission to the neonatal intensive care unit
COMPLICATIONS
Macrosomia
The velocity of fetal weight gain peaks at approximately 37 weeks
Although growth velocity slows at that time, most fetuses continue to gain weight
Medical or Obstetrical Complications
• It is generally not recommended that a pregnancy be allowed to continue
past 42 weeks.
• Indeed, in many such instances, earlier delivery is indicated.
• Common examples include gestational hypertensive disorders, prior cesarean
delivery, and diabetes.
MANAGEMENT
Management of postterm pregnancy
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